Diagnosis and Management of Nitazene Dependence in Sydney, Australia: A Case Series.
Daniel Dutkiewicz, Hester Wilson, Peter Chisholm et al.
✦ AI-curated · Sources linked
Case in brief
Six young adult men presented to a metropolitan Sydney public hospital in severe opioid withdrawal after nitazene use. Five had regularly vaped products they believed contained cannabinoids or nicotine; toxicology confirmed protonitazene. The sixth had intentionally used metonitazene recreationally. All began opioid dependence treatment, with four treated as inpatients and two as outpatients. The authors report that all were managed successfully with methadone or buprenorphine in the New South Wales opioid dependence treatment program; four remained engaged in treatment, while two were lost to follow-up.
What made this case unusual
Five patients were unknowingly exposed to protonitazene through vaping products they believed contained cannabinoids or nicotine, contributing to initial diagnostic confusion and delays in toxicological confirmation.
Diagnostic / clinical pearl
Consider nitazene exposure in severe opioid withdrawal, including when patients report vaping products believed to contain other substances; toxicological testing can help clarify the diagnosis.
Why it matters
The authors report that high doses of buprenorphine were required, and that diagnostic, medication and patient factors complicated management. Awareness may support earlier diagnosis and treatment.